Should your doctors' pay be based on how well they care for you? Health insurers, including the federally funded Medicare system, think so.
They are making California a testing ground for standards that could eventually be used to rate all physicians in the country, rewarding them for keeping people healthy and costs down. Consumers could use the information to choose their physicians, and health plans could use it to determine pay or to drop low-performing doctors from their networks of providers.
Proponents say such programs are needed to correct a system that now rewards doctors even if they run up patient bills with excessive treatments.
Integrated Healthcare Assn.: An article in Business on Thursday about efforts to tie physician pay to performance said a voluntary program in California, called Integrated Healthcare Assn., had paid $145 million in incentives to doctors groups since it began in 2003. Health insurance companies that participate in the program pay the rewards directly to physician groups.
"We pay even if doctors make mistakes, run unnecessary tests and have to redo their work," said Peter Lee, chief executive of Pacific Business Group on Health, a California coalition of employers that represent some of the largest buyers of health insurance in the state.
Currently there is no national set of performance standards against which doctors are measured. Many doctors warn that the standards must be carefully crafted or they could penalize good doctors. They point to performance measures recently introduced by some private health plans that have been heavily criticized as unfair.
Although health insurers have created their own performance measures, none has tied physician pay to such measures yet. But California is a pioneer with a state system that rates physician groups and financially rewards them with cash prizes for improving preventive care and patient satisfaction. This week, the state also joined a federal program to rate individual doctors.
"I keep telling doctors, no matter how good the food is at a restaurant, if the service is bad, the customers won't come back," said Donald Rebhun, an internist in Mission Hills and a medical director for Torrance-based HealthCare Partners, one of the largest medical groups in the state. It participates in a statewide program that rewards doctor groups for performance.
Late last year, the Washington State Medical Assn., a physician trade group, sued a local health plan that had tried to exclude some doctors from its network of providers based on its review of their performance. The suit is pending.
Blue Cross Blue Shield of Texas recently suspended rolling out its physician performance ratings because of negative reaction by the state's doctors, who said the ratings were incomplete and unfair.
